Therapeutic Plasma Exchange (Plasmapheresis) for Longevity — Blood & Plasma Interventions
Replacing a patient's plasma with albumin/saline to dilute pro-inflammatory, pro-aging circulating factors — Conboy protocol showed 50% plasma dilution reverses multiple aging hallmarks in mice.
Overview
Therapeutic Plasma Exchange (TPE) removes a patient's plasma and replaces it with albumin, fresh frozen plasma (FFP), or saline + albumin. Historically used for autoimmune diseases (myasthenia gravis, AIDP, TTP, NMO), TPE has attracted longevity interest following Irina Conboy's (UC Berkeley) parabiosis research. The Conboy lab's 2022 Nature Aging paper demonstrated that heterochronic parabiosis (sharing circulation between young and old mice) reverses multiple aging markers — and critically, the benefit accrued to old mice is NOT because of young blood factors, but because DILUTION of old blood factors (GDF11 controversy aside). Subsequent experiments showed simple dilution of old plasma with neutral albumin/saline was sufficient to rejuvenate multiple tissues in old mice. The mechanism appears to involve dilution of TGF-β1, B2M (beta-2-microglobulin), and other pro-aging circulating factors. Several longevity clinics (Kiprov clinic in San Francisco) are now offering TPE for longevity in healthy individuals. Alkahest, a Grifols company, is conducting human trials.
Indications
- Longevity intervention targeting circulating aging factors (research/experimental context)
- Autoimmune diseases (FDA-approved uses: myasthenia gravis, GBS, AIDP, TTP, hyperviscosity syndromes)
- Elevated pro-aging factors (TGF-β1, B2M) on testing
- High-risk cardiovascular patients with elevated Lp(a) or fibrinogen (adjunct to apheresis)
Mechanism of Action
TPE mechanically removes TGF-β1, beta-2-microglobulin, VCAM-1, and other circulating pro-aging factors that inhibit stem cell activity, promote inflammation, and impair tissue regeneration
Dosing
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Therapeutic Plasma Exchange (Conboy protocol) | 1-1.5 plasma volumes (typically 2.5-3 liters) replaced with 5% albumin + saline | 1-2 sessions annually for longevity; up to weekly for autoimmune indications | Longevity use experimental; Conboy dilution ratio: 50% plasma replaced with neutral solution; research clinic protocol varies |
Evidence Grade
GRADE C
Safety & Contraindications
- Requires IV central or large-bore peripheral access — procedure risk including hematoma, infection, pneumothorax with central lines
- Citrate anticoagulation during procedure causes transient hypocalcemia — paresthesias, muscle cramps; treated with IV calcium
- Allergic reactions to FFP or albumin replacement fluids
- Hemodynamic instability possible, especially in medically frail patients
- Removes beneficial plasma proteins (immunoglobulins, clotting factors) alongside harmful factors — immunoglobulin replacement sometimes required
- FDA-approved only for specific autoimmune indications; off-label for longevity; insurance will not cover for longevity use
- Cost: $3,000-8,000 per exchange (cash-pay for longevity use)